NO PERMIT NUMBERLOT NO.
NO. a STREF.I'
APPLICATIO F LING PERMIT
CI T O
Sanita
Date
October 996 s 1968 Pe i �-No
Fees �2 I Jt
Application is hereby made to ve oFy oras @ Wf �cl permit to install Plumbing
pipes and/or fixtures listed on the reve'rse sI e h r o'P, taxi agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other Taws applicable thereto.
Use of Premises Dwelling
Ditz Crane Company 2295 tie La Cruz Boulevard
Owner Address,
By
State
r
Palm Plumbing Company
245
2323 CTOA, AGGNT
186579
12Sunnyvale-Saratoga Rd.
TcrFress
WILLL".iti D. L'�N2'./ICH
4— PLUMBING INSPECTOR ✓
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
f
Size
Water Closet
Material
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen ink
l
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink R Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee 1,3j
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /}
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee nc.
Total
Total Fee o'1�